营养风险指数预估老年血液透析患者病死率的价值被引量：25

Value of the Geriatric Nutritional Risk Index in predicting mortality of elderly patients undergoing hemodialysis

导出

摘要目的探讨营养风险指数（GNRI）在预估老年血液透析患者病死率中的价值。方法回顾性分析上海交通大学附属第一人民医院肾内科2007年1月至2015年4月125例老年血液透析患者的临床资料。所有患者入组前透析时间超过6个月，计算GNRI指数，根据GNRI指数四分位数分为4组，以患者死亡为终点事件，采用Kaplan–Meier分析和cox回归模型分析两者关系，用ROC曲线分析GNRI对患者病死率的预测价值。结果4组老年血液透析患者GNRI指数分别为第1组≤92.06，第2组92.07～96.15，第3组96.16～101.25，第4组≥101.26，4组全因病死率分别为68.8%、58.1%、45.2%和25.8%（P＝0.002），心血管病死率分别为50.0%、33.3%、26.1%和11.5%（P＝0.013）。Kaplan–Meier分析结果提示随着GNRI的升高，5年总体生存率升高，cox回归分析结果显示GNRI与老年血液透析患者病死率显著相关（HR＝0.940，P＝0.001，95%CI：0.907～0.974），与心血管死亡显著相关（HR＝0.906，P〈0.001，95%CI： 0.863～0.951）。ROC曲线提示GNRI预测全因病死率和心血管病死率曲线下面积分别为0.667（P＝0.001）和0.717（P＝0.001）。结论GNRI作为一个简单易行的客观评价指标，与血液透析患者的预后密切相关。 ObjectiveTo explore the reliability of the Geriatric Nutritional Risk Index （GNRI） as a mortality predictor in elderly patients undergoing hemodialysis （HD）.MethodsA total of 125 maintenance HD patients aged 〉60 years old who had received dialysis for over 6 months before entry was retrospectively examined. The values of GNRI were calculated, and death was taken as the end point. The patients were divided into 4 groups according to the quartiles of GNRI values. All-cause and cardiovascular mortality were calculated using Kaplan-Meier and cox proportional-hazards analyses, and ROC curve was adopted for analyzing the predicting value of GNRI on mortality.ResultsThe GNRI of the four groups were ≤92.06, 92.07-96.15, 96.16-101.25, ≥101.26, respectively. Kaplan-Meier survival rate was significantly different among 4 groups for all-cause and cardiovascular mortality. Cox regression model analysis demonstrated that the GNRI was a predictor for all cause （HR=0.940, P=0.001, 95%CI： 0.907-0.974） and cardiovascular mortality （HR=0.906, P〈0.001, 95%CI： 0.863-0.951）. The area under ROC curve was 0.667 （P=0.001） for all-cause mortality and 0.717 （P=0.001） for cardiovascular mortality.ConclusionThe GNRI is a reliable predictor for all-cause mortality in maintainance HD patients, but more multi-center studies with larger samples are still needed.

作者张郁苒张政于青袁伟杰

机构地区上海交通大学附属第一人民医院肾内科

出处《中华医学杂志》 CAS CSCD 北大核心 2015年第46期3741-3745,共5页 National Medical Journal of China

关键词血液透析老年营养风险指数营养评估病死率 Hemodialysis Geriatric nutritional risk index Nutritional assessment Mortality

分类号 R692.5 [医药卫生—泌尿科学]

引文网络
相关文献

参考文献18

1Misra M. Dialysis in the elderly [ J ]. Blood Purif, 2008,26 ( 1 ) : 41-44.
2Takahashi H, Ito Y, Ishii H, et al. Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients[J]. J Cardiol,2014,64( 1 ) :32-36.
3Bouillanne O, Morinean G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients [ J ]. Am J Clin Nutr,2005,82 (4) :777-783.
4Komatsu M, Okazaki M, Tsuchiya K, et al. Geriatric nutritional risk index is a simple predictor of mortality in chronic hemodialysis patients [ J ]. Blood Purif, 2015, 39 (4) :281-287.
5Combe C, Chauveau P, Laville M, et al. Influence of nutritional factors and hemodialysis adequacy on the survival of 1 610 French patients[ J]. Am J Kidney is,2001,37 ( 1 Suppl 2) : $81-$88.
6Su CT, Yabes J, Pike F, et al. Changes in anthropometry and mortality in maintenance hemodialysis patients in the HEMO study [J]. Am J Kidney Dis,2013,62(6) :1141-1150.
7Carrero JJ,Stenvinkel P,Cuppari L,et al. Etiology of the protein- energy wasting syndrome in chronic kidney disease: a consensus statement from the international society of renal nutrition andmetabolism (ISRNM) [ J ]. J Ren Nutr,2013,23 (2) : 77-90.
8Kalantar-Zadeh K, Kopple JD, Block G, et al. A malnutrition- inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients[ J ]. Am J Kidney Dis,2001, 38(6) : 1251-1263.
9Kim Y, Molnar MZ, Rattanasompattikul M, et al. Relative contributions of inflammation and inadequate protein intake to hypoalbuminemia in patients on maintenance hemodialysis [ J ]. Int Urol Nephrol,2013,45 (1) :215 -227.
10Johansen KL, Kutner NG,Young B,et al. Association of body size with health status in patients beginning dialysis [ J ]. Am J Clin Nutr,2006,83 ( 3 ) :543-549.